person centred dementia care: are you serious?? · person centred dementia care: are you serious??...

Person Centred Dementia

Care: Are you serious??

Professor Dawn Brooker

University of Worcester

Association for Dementia Studies

UK

University of Worcester Association for

Dementia Studies

Is this reality?

In care homes every resident is regarded as precious. Their needs are anticipated and met without delay. Days are full of joy and free from anxiety. Every single member of the staff team is confident and skilled and exudes warmth and kindness. Families are welcomed as old friends. This happens every day of the week and every hour of the day, regardless of who is on duty or leading the care team. It has been like this for over 5 years.

Person Centred Approaches to

people living with dementia

1992 Tom Kitwood: Towards a theory of personhood in dementia care

2006 NICE –SCIE guidelines on dementia care UK Govt recommend person centred care

Bowlby and attachment theory

into practice

• 1940 First theoretical paper

• 1950 WHO paper endorsing Bowlby’s position regarding children needing a continuous “mother”figure

How long until change

becomes institutionalised?

• 1949 1949 1949 1949 my 3-year old brother spends 5 weeks in hospital with no contact at all with his mum

• 1967196719671967 Aged 8, I spend 3 days in hospital for a tonsillectomy – my mum visits 3 times

• 1995199519951995 my 5 week old baby spends 5 days in hospital – I sleep on the floor next to his cot

• 2005200520052005 my 10 year old has an appendectomy – I have a bed next to him and a family sitting room

Using the same timescale we should

have institutionalised person centred

care for people with dementia by

2057

University of Worcester Association for

Dementia Studies

The Sisyphean Task of

achieving person centred care

DementiaDementiaDementiaDementia----ist society ist society ist society ist society Lack of resourcesLack of resourcesLack of resourcesLack of resourcesLack of political willLack of political willLack of political willLack of political willTask centred care cultureTask centred care cultureTask centred care cultureTask centred care cultureLack of clarity Lack of clarity Lack of clarity Lack of clarity Lack of skillsLack of skillsLack of skillsLack of skillsLack of leadershipLack of leadershipLack of leadershipLack of leadershipUs and them divideUs and them divideUs and them divideUs and them divideInstitutionalisationInstitutionalisationInstitutionalisationInstitutionalisationThanks to Paul Whitby for Sisyphus

Is there a natural cycle of

trying to do person centred

care?

Post person-centred care?

• New perspectives and professional models....• Relationship centred care, emotion oriented care,

TLC care, evidence based practice ......• Makealotofmoney Care Ltd. • Reduction of person centredness to non-cognitive &

non-pharmacological approaches• Find a pharmacological solution for problem

behaviours

Kitwood predicted post-

person centred care..

“It is conceivable that most of the advances that have been made in recent years might be obliterated, and that the state of affairs in 2010 might be as bad as it was in 1970, except that it would be varnished by eloquent mission statements, and masked by fine buildings and glossy brochures”

Tom Kitwood Dementia Reconsidered p 133

Post person centred care:

The task of cultural

transformation

The question remains as to how can we change the face of long-term care for people with dementia to person centred? Where is the leadership for this?

The answer, gentle reader, is that it comes from you.

Brooker, 2007

Defining person centred care

• In itself it is not a single intervention• It is not non-pharmacological or non-cognitive• Person centred care provides a set of guiding

principles for our actions in the field of dementia care that enable people with dementia to be in relationship with others.

PCC = V + I + P + S

V = ValuesValues people

I = IndividualIndividuals s

needsneeds

P = Perspective Perspective of

service user

S = SupportiveSupportivesocial psychology

Brooker, D. (2004) What is Person Centred Care for people with dementia? Reviews in Clinical Gerontology 13 (3). 215-222.

Brooker, D. (2007) Person Centred Dementia Care: Making services betterLondon, Jessica Kingsley Publications

Guiding Principles

• Do my actions value and honour people living with dementia?

• Do I recognise the individual uniqueness of the people I work with?

• Do I make a serious attempt to see my actions from their perspective or stand point?

• Do my actions provide the support for people with dementia to feel socially confident and that they are not alone?

The Person-Centred Care Provider

VALUINGVALUINGVALUINGVALUINGV1 vision V1 vision V1 vision V1 vision V2 human resource management V2 human resource management V2 human resource management V2 human resource management V3 management ethos V3 management ethos V3 management ethos V3 management ethos V4 training & staff developmentV4 training & staff developmentV4 training & staff developmentV4 training & staff developmentV5 the service environmentsV5 the service environmentsV5 the service environmentsV5 the service environmentsV6 quality assuranceV6 quality assuranceV6 quality assuranceV6 quality assurance

INDIVIDUALISEDINDIVIDUALISEDINDIVIDUALISEDINDIVIDUALISEDI 1 care planning I 1 care planning I 1 care planning I 1 care planning I 2 regular reviews I 2 regular reviews I 2 regular reviews I 2 regular reviews I 3 personal possessions I 3 personal possessions I 3 personal possessions I 3 personal possessions I 4 individual preferences I 4 individual preferences I 4 individual preferences I 4 individual preferences I 5 life history workI 5 life history workI 5 life history workI 5 life history workI6 activity & occupationI6 activity & occupationI6 activity & occupationI6 activity & occupation

PERSPECTIVEPERSPECTIVEPERSPECTIVEPERSPECTIVEP1 communication P1 communication P1 communication P1 communication P2 empathy & acceptable risk P2 empathy & acceptable risk P2 empathy & acceptable risk P2 empathy & acceptable risk P3 physical environment P3 physical environment P3 physical environment P3 physical environment P4 physical health needs P4 physical health needs P4 physical health needs P4 physical health needs P5 challenging behaviourP5 challenging behaviourP5 challenging behaviourP5 challenging behaviourP6 advocacyP6 advocacyP6 advocacyP6 advocacy

SOCIAL/PSYCHOLOGICALSOCIAL/PSYCHOLOGICALSOCIAL/PSYCHOLOGICALSOCIAL/PSYCHOLOGICALS1 inclusion S1 inclusion S1 inclusion S1 inclusion S2 respect S2 respect S2 respect S2 respect S3 warmthS3 warmthS3 warmthS3 warmthS4 validation S4 validation S4 validation S4 validation S5 enabling S5 enabling S5 enabling S5 enabling S6 part of family & communityS6 part of family & communityS6 part of family & communityS6 part of family & community

Indicators of valuing

1. Every life is precious?

2. Do staff feel valued?

3. Staff act in best interests of service

users?

4. Skilled work-force?

5. Physical & social care environments?

6. QA processes service user focussed?

Excellent, Good, OK, Needs serious work?Excellent, Good, OK, Needs serious work?Excellent, Good, OK, Needs serious work?Excellent, Good, OK, Needs serious work?

Indicators of Individualised

approach

1. Care planning across all needs?2. Responsive to change?3. Personal clothing and possessions?4. Individualised preferences & routines?5. Key stories of proud times?6. Occupation & activities ?


Indicators of the taking the

perspective

1. Skilled Communicators?2. Empathy and risk balance? 3. Comfort needs managed?4. Physical health needs anticipated? 5. “Challenging behaviour” seen as communication? 6. Advocacy?


Indicators of providing social-

psychological support

1. Included or talked over? 2. Respect or disregarded?3. Warmth or coldness? 4. Distress taken seriously or ignored? 5. Helping to do, or doing to? 6. Community or institution?


Listening to what people tell

us about living in a care homeChoi, Ransom and Wyllie (2008) Depression in Older Nursing

Home Residents: The Influence of Nursing Home Environmental

Stressors, Coping, and Acceptance of Group and Individual

Therapy

Harmer & Orrell (2008) What is meaningful activity for people with

dementia living in care homes: A comparison of the views of

older people with dementia, staff, and family carers

Walsh and Waldmann (2008) The Influence of Nursing Home

Residency on the Capacities of Low-Dependency Older Adults

What people in care homes tell

us now:

• Give me a life worth living Give me a life worth living Give me a life worth living Give me a life worth living –––– fun, fun, fun, fun, relationships and something to relationships and something to relationships and something to relationships and something to look forward to, not look forward to, not look forward to, not look forward to, not antidepressants.antidepressants.antidepressants.antidepressants.

• Moving into a care home is a Moving into a care home is a Moving into a care home is a Moving into a care home is a huge life event. It was a shock. huge life event. It was a shock. huge life event. It was a shock. huge life event. It was a shock. Help me through it. Help me through it. Help me through it. Help me through it.

• I want to maintain familiar touchI want to maintain familiar touchI want to maintain familiar touchI want to maintain familiar touch----stones of my lifestones of my lifestones of my lifestones of my life

• Remembering the old days and Remembering the old days and Remembering the old days and Remembering the old days and having a singhaving a singhaving a singhaving a sing----song is greatsong is greatsong is greatsong is great

• Death is part of life. I have a lot of Death is part of life. I have a lot of Death is part of life. I have a lot of Death is part of life. I have a lot of experience of coping with hard experience of coping with hard experience of coping with hard experience of coping with hard times. Build on this. times. Build on this. times. Build on this. times. Build on this.

• Give us a stable, well trained Give us a stable, well trained Give us a stable, well trained Give us a stable, well trained staff group in adequate number. staff group in adequate number. staff group in adequate number. staff group in adequate number.

• I like spending time with my I like spending time with my I like spending time with my I like spending time with my family. family. family. family.

• I donI donI donI don’’’’t want to share a bathroom t want to share a bathroom t want to share a bathroom t want to share a bathroom or bedroom. or bedroom. or bedroom. or bedroom.

• Give me a break from people that Give me a break from people that Give me a break from people that Give me a break from people that get on my nervesget on my nervesget on my nervesget on my nerves

2057........

In care homes every resident is regarded as precious. Their needs are anticipated and met without delay. Days are full of joy and free from anxiety. Every single member of the staff team is confident and skilled and exudes warmth and kindness. Families are welcomed as old friends. This happens every day of the week and every hour of the day, regardless of who is on duty or leading the care team. It has been like this for over 5 years.

Thank you for listening!

Come and talk to me!

Dawn Brooker

University of Worcester

Association for Dementia Studies

[email protected]

Tel +44 (0) 1905 855250

Photographs of people living with dementia taking part in

The Enriched Opportunities Programme

person centred dementia care: are you serious?? · person centred dementia care: are you serious??...

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